Can a graft be placed over a flap in complex hypospadias surgery? An experimental study in rabbits

Vol. 42 (6): 1228-1236, November – December, 2016

doi: 10.1590/S1677-5538.IBJU.2016.0168


ORIGINAL ARTICLE

Ricardo Marcondes de Mattos 1, Sérgio R.R. de Araújo 2, Juliany Gomes Quitzan 2, Bruno Leslie 1, Herick Bacelar 1, João Luiz Gomes Parizi 1, Gustavo Marconi Caetano Martins 1, Marcela Leal da Cruz 1, Antonio Macedo Jr. 1

1 Universidade Federal de São Paulo, São Paulo, Brasil; 2 Universidade Estadual Paulista, Botucatu, Brasil

 

ABSTRACT

Purpose: To develop a rabbit experimental study to test the hypothesis that surgical repair of hypospadias with severe ventral curvatures might be completed in one stage, if a graft, such as buccal mucosa, could be placed over the tunica vaginalis flap used in corporoplasty for ventral lengthening, with the addition of an onlay preputial island. flap to complete the urethroplasty.

Materials and methods: The experimental procedure with rabbits included a túnica vaginalis flap for reconstruction of the corpora after corporotomy, simulating a ventral lengthening operation. A buccal mucosa graft was placed directly on top of the flap, and the urethroplasty was completed with an onlay preputial island flap. Eight rabbits were divided into 4 groups, sacrificed at 2, 4, 8 and 12 weeks postoperatively, and submitted to histological evaluation.

Results: We observed a large number of complications, such as fistula (75%), urinary retention (50%) and stenosis (50%). There were two deaths related to the procedure.

Histological evaluation demonstrated a severe and persistent inflammatory reaction. No viable tunica vaginalis or buccal mucosa was identified.

Conclusions: In this animal model, the association of a buccal mucosa graft over thetunica vaginalis flap was not successful, and resulted in complete loss of both tissues.

Keywords: Hypospadias; Urogenital Abnormalities; Urologic Surgical Procedures

[Full Text]


print